Healthcare Provider Details

I. General information

NPI: 1750774055
Provider Name (Legal Business Name): BRENDAN WEISHAAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 CASTLEMAINE DR
BIRMINGHAM AL
35226-5925
US

IV. Provider business mailing address

1156 CASTLEMAINE DR
BIRMINGHAM AL
35226-5925
US

V. Phone/Fax

Practice location:
  • Phone: 251-490-1854
  • Fax:
Mailing address:
  • Phone: 251-490-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-114469
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: